Provider Demographics
NPI:1467628156
Name:THORACIC SURGERY OF INDIAN RIVER LLC
Entity Type:Organization
Organization Name:THORACIC SURGERY OF INDIAN RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEIRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-2009
Mailing Address - Street 1:14430 US HIGHWAY 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3289
Mailing Address - Country:US
Mailing Address - Phone:772-589-2009
Mailing Address - Fax:772-589-2299
Practice Address - Street 1:14430 US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3289
Practice Address - Country:US
Practice Address - Phone:772-589-2009
Practice Address - Fax:772-589-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80733208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2610659OtherCIGNA
FL35676OtherBCBS FLORIDA
613325100OtherFEDERAL BLACK LUNG
FL7435144OtherAETNA
FLDN6310OtherMEDICARE RAILROAD
FL162138OtherWELLCARE
FLPRO6612OtherQUALITY HEALTH PLAN
FL1865828OtherAETNA FL
FL7435144OtherAETNA
FLDN6310Medicare PIN